Prognostication of complications in patients with diseases of gallbladder after laparoscopic cholecystectomy

Objective. To elaborate a prognostic classification of possibilities for occurrence of іntra- and postoperative complications, basing on determination of a premorbid state and the risk factors, concerning operative intervention in patients, suffering surgical diseases of gallbladder. Маterials and methods. Retrospective analysis of treatment of 911 patients, suffering cholelithiasis disease, оperated by the laparoscopic cholecystectomy procedure, was conducted, and factors of possibility of occurrence for іntra- and postoperative complications were determined with further establishment of their criteria. Results. The factors of risk for the complications occurrence after laparoscopic cholecystectomy in patients with diseases of gallbladder (n=911) were investigated. Prognostication pattern of the complications occurrence was built, taking into account the results of correlation-regression analysis conducted, and on its base the clinic-epidemiological groups of the complications risk were formatted with determination of their frequency of confidence intervals. Conclusion. Theoretical substantiation and scientific-practical decision of the task was presented, concerning raising of efficacy of miniinvasive operative interventions in patients with diseases of gallbladder, using elaborated methods of prophylaxis and surgical treatment of complications.

PREMORBIDITY IN ACUTE INFLAMMATION OF THE MAXILLOFACIAL AREA IN CHILDREN

Current state-of-the-art technologies facilitate studying the role of internal and external factors at a higher organ-specific level, and the broad and systematic provision of treatment and prevention care for child population of all age groups differs favorably from the routine visit to a doctor, if necessary. Apparently, the above methodological approach enables establishing different responses of the body to damaging factors in each case. Methods and Material. 537 case histories of children with acute purulent odontogenic and neodontogenic inflammation of the maxillofacial area have been thoroughly studied. Only medical histories of in-patients have been selected. Results and Discussion. The analysis of premorbid state of 240 patients with acute purulent lymphadenitis has shown that the onset of the diseases was triggered by the experienced ARVI in 89 patients (37%) and in 37 cases (15%) inflammation of the lymph nodes coincided with manifestations of acute pathology of the ENT organs; in 34 (14%) cases it was combined with acute inflammation of the bronchopulmonary system, in 23 (10%) cases with disorder of the gastrointestinal tract (GIT), in 13 (6%) cases it was provoked by acute periodontitis and exacerbation of chronic periodontitis in temporary and permanent molars of the mandible. Concomitant chronic somatic diseases were detected in 122 patients (51%). They most often occurred in toddlers, preschoolers and school-aged children and related, in most cases, to the respiratory tract and ENT organs. Precursors of adenophlegmon in 150 patients were ARVI (45 children (30%)); acute inflammation and exacerbation of chronic ENT processes (21 children (14%)); pathological changes in the bronchopulmonary system (19 children (13%)); gastrointestinal disorders (15 children (10%)); acute periodontitis and exacerbation of chronic periodontitis in temporary molars (20 children (13%)), permanent molars (6 (4%)); acute inflammation of the oral mucosa (5 children (3%)); pyoderma (4 children (3%)). In 15 children (10%) the provoking factor for the development of adenophlegmon failed to be established. Concomitant chronic somatic pathology was diagnosed in 100 children out of 150 (66.7%), and combination of two chronic diseases was found in 6 children (6%). Most often, the chronic course of somatic pathology was established in preschoolers, less frequently in toddlers and school-aged children, and infrequently during breastfeeding. In acute odontogenic osteomyelitis, the source of infection was temporary molars in all toddlers and preschoolers, as well as in 12 school-aged children (18%). In total, the onset of osteomyelitis was triggered by temporary teeth in 67 cases (46%). Notably, 35 cases (52%) were related to the first molar and 32 (48%) cases to the second molar. Complicated dental caries in permanent second premolars caused osteomyelitis in 2 (14%) adult children only. Permanent molars caused the development of purulent process in 78 cases (53%). The analysis of the premorbid state has revealed that the onset of osteomyelitis was preceded by: ARVI (42 children (29%)); general hypothermia (37 (25%)), inflammation of the ENT organs (21 children (14%)) and bronchopulmonary system (15 (10 %)); exacerbation of chronic gastrointestinal diseases (8 children (5%)) and in 24 children (16%) a provoking factor failed to be established. Concomitant chronic diseases of organs and systems were found in 90 children (61.2%) out of 147 with acute odontogenic osteomyelitis of the mandible. The combination of their two nosological forms was noted in 3 children (3%). In conclusion, the establishment of certain adverse factors, or the presence of somatic diseases in children necessitates the formation of a risk group, especially when it comes to the existence of odontogenic foci of inflammation. Timely establishment of factors that can be influenced enables control over them through preventive measures, including routine dental check-ups.

Long-term outcomes of surgical rib fixation in patients with flail chest and multiple rib fractures

BackgroundRecently, interest has increased in surgical fixation for severe thoracic wall injury with good short-term outcomes. However, few reports have evaluated long-term outcomes or complications. This study aimed to assess long-term quality of life and implant-related complications after rib fixation for flail chest and multiple rib fractures.MethodsWe interviewed patients who had undergone rib fixation from January 2014 to December 2019 about their current ability to work and their usual life.ResultsTwenty-two patients underwent rib fixation during the study period. Two patients with flail chest had already died after the surgery due to senescence; thus, follow-up information was obtained from 20 patients (91%), with a follow-up duration of 47.5 (IQR 22–58) months. The most undesirable event occurring during the study period was irritation caused by a palpable plate (n=2, 10%), probably due to the thin skin of patients over 70 years old. Eighteen patients were able to return to their usual life or same work as in the premorbid state with no complaints. Two patients are still undergoing rehabilitation due to concomitant extremities fractures. The median EQ-5D-5L index score was 0.89 (IQR 0.84–0.93). There were no implant-related complications requiring plate explantation.DiscussionWe concluded that rib fixation offers good long-term benefits, with the ability of the patient with flail chest or multiple rib fractures to return to activity in the premorbid state. Elderly patients especially with thin, soft tissue may complain of irritation caused by the plate and should be informed of this prior to surgery.Level of evidenceLevel IV therapeutic care/management.

ІНФОРМАЦІЙНІ ТЕХНОЛОГІЇ ВИВЧЕННЯ АДАПТАЦІЙНОЇ ЗДАТНОСТІ СЕРЦЕВО-СУДИННОЇ СИСТЕМИ ДО ФІЗИЧНОГО НАВАНТАЖЕННЯ ЗА МОРФОЛОГІЧНИМ, ЧАСОВИМ ТА СПЕКТРАЛЬНИМ АНАЛІЗОМ ОСЦИЛОГРАМ

Offer Author Information Technology morphological, temporal and spectral analysis of waveforms (recorded at rest and after exercise), the introduction of analytical treated for clinical interpretation of the results, evaluation and decision-making to doctors significantly increases the information content of the procedure of blood pressure measurement. Can be used for early detection and prenosological premorbid state and functional reserve of the circulatory system, help more effectively to plan preventive, diagnostic and therapeutic process.

Triphasic umbilical artery waveform: association with severe fetal growth restriction, fetal demise, and extreme velamentous cord insertion

Extreme Doppler abnormalities of the umbilical artery such as absent or reversed end diastolic velocity are associated with adverse perinatal outcomes. We present a case of a triphasic umbilical artery waveform identified at 24 weeks. The fetus was severely growth restricted with an estimated fetal weight of 314 g. A week later, fetal demise occurred. Placental pathology revealed a placental weight of 83 g, an extensive maternal floor infarction, and an extreme velamentous cord insertion 7 cm from the edge of the placental disc, with vessels entering at opposite poles of the placental disc and a single anastomotic bridging vessel on the chorionic plate connecting these two vascular poles. A triphasic umbilical artery waveform may be associated with a premorbid state and severe placental vascular abnormality. We hypothesize that the third and positive component in late diastole is present due to forward flow across the communicating bridging vessel into the contralateral entering vessel.

Preventive Medicine

Preventive medicine is the practice of medicine that detects and alters or ameliorates host susceptibility in a premorbid state (eg, immunization), risk factors for disease in a predisease state (eg, increased cholesterol level), and disease in the presymptomatic state (eg, in situ cervical cancer). Not all disease is preventable because not all risk factors (or all individuals at risk) are known, the cost of screening everyone is not feasible, barriers to medical access exist, interval disease occurs, characteristics of the target disease vary, and screening tests and treatments are imperfect.

Childhood psychopathological antecedents in early onset schizophrenia

ObjectiveTo describe the premorbid state of early onset schizophrenia (EOS).MethodsTwenty-three adolescents with EOS were compared to a healthy control group (CG) and to a group of anorexic patients (AG). The premorbid state was studied through the CBCL and the data obtained were analyzed using ANOVA’s and t-test.ResultsDuring the premorbid period EOS showed significantly higher scores on all scales, relative to the CG, and only on some scales (social, thought and attention problems, and school competencies) relative to the AG.ConclusionsChildren who develop first episode psychosis during adolescence differ from children with normal development. The premorbid internalizing state is common to AG but social competencies and school problems are the most affected areas in EOS when compared to the AG. It is hypothesized that both EOS and AG can be considered as the expression of a previous vulnerability.

Haemostasis in acute myocardial infarction

Acute myocardial infarction (AMI) is caused by a localized arterial thrombosis, which resulted with myocardial ischemia and necrosis. This event causes the reaction of heart muscle (akinesis and dyskinesis of the ischemic parts of myocardial wall, arrhythmias, and haemodinamic disturbances) and severe systemic reaction (activation of neuroendocrine axis and inflammatory response). Haemostatis disturbances, which can be detected during the AMI and partly caused by the local coronary thrombosis, and partly by the mentioned heart and systemic reaction. A number of therapeutic procedures like venepuncture and almost all drugs commonly used, also influence the measurement of haemostatic parameters. Premorbid state, like smoking diabetes, hyperchlosterolemia, hypertension and obesity and also strong modulators of haemostatis disturbances in AMI and to light on the main factors which modulate that complicated process.

Functional aphonia in young people

The study reviewed the case histories of 14 young aphonies. A questionnaire was completed by the five speech therapists involved with these cases. The patients were all initially examined by E.N.T. specialists and then treated by speech therapy. All the patients were ‘cured’ by speech therapy, that is the voice returned to its premorbid state. This study looks at common characteristics of presentation, different approaches to management, and the patterns of voice return.